Complaint Inquiry Complainant Information (Person filing ...

Business License Division

Complaint

Inquiry

Complainant Information (Person filing complaint):

Name:

Address:

City:

State:

Phone Number: Best Time for Contact: Zip Code:

I am supplying the following information to the City of North Las Vegas, Business License Division, to determine whether or not a violation of the City Business License Code has occurred and if further action is necessary. I understand that the City of North Las Vegas, Business License Division has limited ability to regulate how a person operates their business and/or the quality of their product or service. I also understand that the City of North Las Vegas, Business License Division cannot act in any legal capacity in resolving a complaint nor can it promise refunds or other remedies in connection with this complaint. I acknowledge that the information supplied in this form is true and accurate to the best of my knowledge. Further, the information is being submitted voluntarily and is given for the sole purpose of assisting the City of North Las Vegas, Business License Division in the enforcement of its Business License Code.

Complainant Signature:

Please return completed form to: City of North Las Vegas Business License Division 2250 N. Las Vegas Boulevard Suite 110 North Las Vegas, NV 89030

Date:

Office Use Only:

Walk In Fax Mail In

Complaint Received By:

Date:

Officer Assigned:

2250 N. Las Vegas Boulevard Suite 110

North Las Vegas, Nevada, 89030 702-633-1520 (Select Option 3)

702-399-8099 (Fax)

Revised 11/21/2011

City of North Las Vegas Business License Division Complaint Form Page 2

Offender Information:

Business Name:

Address:

City:

State:

Cell Phone:

Pager:

Business Owner Name(s)/Contact Name(s):

Descriptive Information Regarding Offender:

Name:___________________________________

Male

Female

Race:

Height:

Weight:

Hair Color:

Eye Color:

Facial Hair:

Noticeable scars, tattoos or unusual features:

NLV License Number: Phone Number: Zip Code: Fax:

Vehicle Information Related to Offender: Make: Model: Color: License Plate Number: State: Additional Descriptors (i.e. ladder racks, tool lockers):

Please list other agencies contacted, such as the County, State or Federal Government.

Agency

Person Contacted

Date Contacted

Phone Number

Fax Number

2250 N. Las Vegas Boulevard Suite 110

North Las Vegas, Nevada, 89030 702-633-1520 (Select Option 3)

702-399-8099 (Fax)

Revised 11/21/2011

City of North Las Vegas Business License Division Complaint Form Page 3

Please detail the nature of your complaint against the above named business. Please try to report factual information only. Describe the events in the order they occurred, to include dates, times and locations. Attach photocopies of any relevant documents, agreements, correspondence, receipts or photos that would support your complaint. Attach additional pages as necessary. Please print clearly.

2250 N. Las Vegas Boulevard Suite 110

North Las Vegas, Nevada, 89030 702-633-1520 (Select Option 3)

702-399-8099 (Fax)

Revised 11/21/2011

City of City of North Las Vegas Business License Division Complaint Form Page 4

Office Use Only:

Ward Number:

Case Number:____________

Case Status

Complaint

Inquiry

Officer Assigned:____________________________

Date Assigned:_____________________

Complainant notified by Officer of receipt of complaint/inquiry on _________________. N/A

Date

Case Closure Status:

Complaint Unfounded

Compliance Attained

Complainant Uncooperative

Corrective Action Taken

Other Jurisdiction/Agency Referred to:______________________

Brief Summary of Action Taken OR See Attached Narrative:

Complainant notified of outcome: N/A

Unable to do so based on lack of contact information.

Notified on ________________________

Method of contact:

In-Person

Email

Mail

Date

Reviewed By: ________________________________

Business License Manager

Phone Date: _______________________________

2250 N. Las Vegas Boulevard Suite 110

North Las Vegas, Nevada, 89030 702-633-1520 (Select Option 3)

702-399-8099 (Fax)

Revised 11/21/2011

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